Background:Few studies have explored the link between body fluid ion levels (sodium, calcium, magnesium, phosphorus) and blood pressure circadian rhythm. This study investigates these ions' relationship with the dipping blood pressure pattern in hypertensive patients, highlighting their potential for monitoring electrolyte levels in hypertension management. Methods:According to 2018 Chinese guidelines for hypertension management, hypertensive patients were classified into dipping/super-dipping and non-dipping/reverse-dipping groups based on nocturnal blood pressure decline. Clinical data and serum/24-hour urine electrolyte levels were then collected from these patients. Logistic regression and advanced statistical modeling were used to identify influencing factors. Results:Age and alpha-blockers negatively correlate with the likelihood of dipping blood pressure in hypertensive patients (P<0.05). Highest chance of dipping occurs at age 54 years, with serum sodium at 139.55 mmol/L and 24-hour urinary calcium at 5.34 mmol (P<0.05). The lowest likelihood is at a 24-hour urinary calcium level of 1.65 mmol (P<0.05). The largest nocturnal systolic drop is at age 57 years, serum calcium at 2.41 mmol/L, and 24-hour urinary calcium at 5.34 mmol (P<0.05). The largest diastolic drop is at age 54 years, with serum sodium at 139.03 mmol/L, serum calcium at 2.42 mmol/L, and serum magnesium at 0.95 mmol/L (P<0.05). A serum calcium level over 2.20 mmol/L significantly boosts the chance of dipping and nocturnal diastolic drop (P<0.05). Conclusion:In hypertensive patients, the chance of a dipping blood pressure pattern declines with age, possibly peaking between 54-57 years. Optimal serum sodium for dipping is 139 mmol/L, and higher serum calcium (peaking at 2.41 mmol/L) increases this likelihood. Alpha-blockers may negatively affect the dipping blood pressure pattern.

BACKGROUND As the burden of mental disorders among patients with atrial fibrillation (AF) increases, researchers are beginning to pay close attention to the risk and prevalence of these comorbidities. Although studies have independently analyzed the risk of comorbidity with depression and anxiety in patients with AF, no study has systematically focused on the global epidemiology of these two mental disorders. AIM To explore the prevalence of depression and anxiety in patients with AF. METHODS Five databases were searched from their date of establishment until January 2023. Observational studies reporting the comorbidity of AF with depression and anxiety, were included in this study. Basic information, such as the first author/ publication year, study year, study type, and prevalence of depression and anxiety, were extracted. STATA SE 15.1 was used to analyze the data. Subgroup, meta-regression, and sensitivity analyses were performed to estimate study heterogeneity. RESULTS After a thorough search, 26 studies were identified and included in this meta-analysis. The prevalence rates of depression and anxiety in adults with AF were 24.3% and 14.5%, respectively. Among adult males with AF, the prevalence was 11.7% and 8.7%, respectively, whereas in females it was 19.8% and 10.1%, respectively. In older adults with AF, the prevalence rates of depression and anxiety were 40.3% and 33.6%, respectively. The highest regional prevalence of depression and anxiety was observed in European (30.2%) and North American (19.8%) patients with AF. CONCLUSION In this study, we found that the prevalence of depression and anxiety among patients with AF varies with sex, region, and evaluation scales, suggesting the need for psychological interventions for patients with AF in clinical practice.

Coronary artery aneurysm (CAA), marked by diffuse or localized dilation of artery, can cause life-threatening complications in acute coronary syndrome. This report presents a case of CAA combined with acute ST-segment elevation myocardial infarction, successfully treated with cardiac rehabilitation exercise therapy, offering insights for clinical practice.

Background:In China, Shen'ge formula (SGF), a Traditional Chinese Medicine blend crafted from ginseng and gecko, holds a revered place in the treatment of cardiovascular diseases. However, despite its prevalent use, the precise cardioprotective mechanisms of SGF remain largely uncharted. This study aims to fill this gap by delving deeper into SGF's therapeutic potential and underlying action mechanism, thus giving its traditional use a solid scientific grounding. Methods:In this study, rats were subjected to abdominal aortic constriction (AAC) to generate pressure overload. Following AAC, we administered SGF and bisoprolol intragastrically at specified doses for two distinct durations: 8 and 24 weeks. The cardiac function post-treatment was thoroughly analyzed using echocardiography and histological examinations, offering insights into SGF's influence on vital cardiovascular metrics, and signaling pathways central to cardiac health. Results:SGF exhibited promising results, significantly enhanced cardiac functions over both 8 and 24-week periods, evidenced by improved ejection fraction and fractional shortening while moderating left ventricular parameters. Noteworthy was SGF's role in the significant mitigation of myocardial hypertrophy and in fostering the expression of vital proteins essential for heart health by the 24-week mark. This intervention markedly altered the dynamics of the Akt/HIF-1α/p53 pathway, inhibiting detrimental processes while promoting protective mechanisms. Conclusion:Our research casts SGF in a promising light as a cardioprotective agent in heart failure conditions induced by pressure overload in rats. Central to this protective shield is the modulation of the Akt/HIF-1α/p53 pathway, pointing to a therapeutic trajectory that leverages HIF-1α promotion and p53 nuclear transport inhibition.

研究显示约40％因胸痛行冠脉造影术的患者未见明显狭窄,其心绞痛症状可能由于冠状动脉微血管病变引起,冠状动脉微血管疾病(Coronary microvascular disease,CMVD)主要由微血管系统的结构异常、血管舒缩功能障碍及自主神经功能紊乱导致心肌缺血心绞痛.同时,CMVD对糖尿病、肾脏疾病、风湿免疫性疾病等诸多疾病的临床表现及预后有重要的影响.尽管已了解到CMVD在多种情况下的病理生理机制,但到目前为止,还没有针对性的特殊治疗方法,因此,加强对CMVD的研究,并为此类患者制定相关的个性化治疗,应是未来缺血性疾病治疗的趋势.

Stroke patients with autonomic dysfunction are more likely to develop cardiac problems, which have been linked to lower functional outcomes and increased mortality. In this study, heart rate variability (HRV) detection paired with the Clinical Feature Scale will be utilized to elucidate the immediate impact of manual acupuncture on autonomic dysfunction of varying severity in the convalescence stroke phase. This is a randomized, single-blind, controlled clinical trial approach. At a ratio of 1:1, 60 appropriate patients will be randomly randomized into either the experimental or control group. On the basis of symptomatic treatment drugs, the experimental group will additionally undertake acupuncture therapy 3 times a week for 4 weeks, for a total of 12 times. Primary outcomes include 24-hour HRV and 60-minute HRV detection at week 4 compared with baseline. The secondary outcome is the score of clinical feature scale at week 4 compared with the baseline. Adverse events and safety indices will be recorded throughout the experiment. The SPSS V.25.0 statistical program was applied for analysis, and measurement data were expressed as mean ± SD.

Doxorubicin, sold under the brand name Adriamycin among others, is an important drug for cancer therapy; however, its use is limited by its cardiotoxicity. Ginsenoside Rg2 is extracted from Panax ginseng C.A.Mey., Araliaceae, which is believed to have cardioprotective properties. However, to date, there have been no reports on whether ginsenoside Rg2 could protect cardiomyocytes against doxorubicin. In this study, we investigated the action and the underlying mechanisms of cardioprotection of ginsenoside Rg2 upon doxorubicin treatment. Cell counting kit-8 was used to determine cell viability; in addition, terminal deoxynucleotidyl transferase–mediated dUTP nick-end labeling staining was used to detect apoptotic cells. Western blotting was used to investigate the relevant pathways. LY294002, a phosphatidylinositol 3-kinase inhibitor, was also used in this study. Ginsenoside Rg2 significantly ( p < 0.01) neutralized cardiomyocyte apoptosis induced by doxorubicin in a dose-dependent manner, but this effect was blocked by LY294002. Furthermore, ginsenoside Rg2 upregulated protein kinase B phosphorylation through the phosphatidylinositol 3-kinase/protein kinase B pathway and inhibited p53 expression. These results suggest that ginsenoside Rg2 could attenuate doxorubicin-induced cardiomyocyte apoptosis via the phosphatidylinositol 3-kinase/protein kinase B pathway. Graphical abstract

目的 观察宁心贴穴位贴敷联合西药治疗心脾两虚型室性早搏的临床疗效.方法 将70例心脾两虚型室性早搏患者随机分为治疗组和对照组,每组35例,对照组予盐酸普罗帕酮治疗,治疗组在对照组治疗措施的基础上加用宁心贴外敷双侧内关穴,两组疗程均为4周.观察临床疗效,比较中医证候积分、24 h动态心电图指标、心律失常危险分层的变化情况.结果 ①治疗组、对照组中医证候总有效率分别为88.57％和60.00％,室性早搏总有效率分别为91.43％和80.00％;两组中医证候疗效、室性早搏疗效比较,治疗组优于对照组(P＜0.05,P＜0.01).②治疗前后组内比较,两组中医证候积分、室性早搏次数均减少(P＜0.05);组间治疗后比较,治疗组中医证候积分、室性早搏次数少于对照组(P＜0.05,P＜0.01).③心率变异性指标[总体标准差(SDNN),平均标准差(SDANN),差值均方根(RMSSD),超过50 ms百分比(pNN50)]变化情况:治疗前后组内比较,两组SDNN、SDANN、RMSSD、pNN50值升高(P＜0.05);组间治疗后比较,治疗组SDNN、SDANN、RMSSD、pNN50值高于对照组(P＜0.05,P＜0.01).④治疗后,两组心律失常危险分层均得到改善(P＜0.05),且治疗组的改善情况优于对照组(P＜0.05).⑤治疗期间,两组均未见明显的不良反应.结论 宁心贴穴位贴敷联合西药治疗心脾两虚型室性早搏疗效满意,与单纯使用西药相比,加用宁心贴穴位贴敷能更好地改善患者的临床症状和预后,且安全性良好.

目的 观察山海丹颗粒对气虚血瘀型老年高血压患者的临床研究.方法 本次临床试验共选取60例老年高血压(气虚血瘀证)患者,按1:1的比例随机分为治疗组和对照组.对照组予口服长效二氢吡啶类钙拮抗剂和安慰剂,治疗组予口服长效二氢吡啶类钙拮抗剂和山海丹颗粒,12周后观察动态血压(ABPM)指标、动态心电图指标、中医症候积分、血脂四项.结果 治疗12周后,治疗组的24h动态收缩压、脉压、收缩压负荷、SDNN及中医证候积分与治疗前比较,差异有统计学意义(P<0.05),治疗组疗效优于对照组(P<0.05).在血脂方面,治疗组与对照组治疗前后比较,差异均无统计学意义(P>0.05).结论 山海丹颗粒对气虚血瘀型老年高血压患者的治疗,能够降低收缩压、脉压、收缩压血压负荷、心率变异性指标,改善临床症状,且安全可行.

心衰是当今社会严重危害人类健康的一种复杂的临床综合征,其致病原因和作用机制复杂,为了更加深入地探索其发病机制和干预途径,需要选择和建立适合的动物模型.通过查阅近几年国内外文献,本文综述了常见的心衰动物模型建模方法及优缺点比较.各种模型有其自身的特点和优势,为今后在心衰模型选择方面提供参考.

目的:利用网络药理学探究附子-淫羊藿药对治疗慢性心功能不全的作用机制,并通过心肌细胞H9c2和斑马鱼模型进行验证.方法:TCM SP采集搜索附子、淫羊藿的目标活性成分,UniProt得到相对应的靶点基因.OMIM,GeneCards获取与慢性心功能不全相关的靶点信息.Cytoscape 3.6.1软件,生成靶点网络图.MetaScape数据库进行蛋白质-蛋白质相互作用(PPI)的分析,基因本体(GO)生物过程,分子功能,细胞组成,京都基因与基因组百科全书(KEGG)通路富集分析.建立心肌细胞H9c2缺氧复氧模型,噻唑蓝(MTT)法测定促增殖效果,蛋白免疫印迹法(Western blot)测定B淋巴细胞瘤-2相关的X蛋白(Bax),B淋巴细胞瘤-2(Bcl-2),半胱氨酸蛋白酶-3(Caspase-3),蛋白激酶B(PKB/Akt),磷酸化蛋白激酶B(p-Akt),细胞外调节蛋白激酶(ERK),磷酸化细胞外调节蛋白激酶(p-ERK),聚腺苷二磷酸核糖聚合酶(PARP)蛋白表达.建立血管内皮生长因子酪氨酸酶抑制剂Ⅱ(VRI)诱导的斑马鱼节间血管损伤模型,验证促血管新生作用.结果:得到药对活性成分28个,209个靶点,1 296个疾病靶点,药对与疾病共同基因靶点94个.PPI聚类提示药对可能通过细胞分化、细胞代谢、血管生成等途径干预慢性心功能不全.GO富集提示药对可能通过改变细胞迁移,血管发育和生成等生物过程治疗慢性心功能不全.10 mg· L-1的淫羊藿,10 mg·L-1的药对能够促进H9c2的增殖(P＜0.05),10 mg·L-1的药对能够上调H9c2的Bcl-2,Bcl-2/Bax,PARP的表达(P＜0.05),降低Caspase-3,Akt,ERK的表达(P＜0.05).药对在0.3,0.1 g·L-1的质量浓度下有明显的促血管新生的作用(P＜0.05).结论:附子-淫羊藿药对可以通过提高Bcl-2,PARP,提高Bcl-2/Bax的比值,降低Caspase-3,Akt,ERK的表达,实现H9c2的缺氧条件下的促增殖作用,同时可以保护斑马鱼损伤的血管,从而通过多成分、多靶点、多途径的治疗慢性心功能不全.

综述室性心律失常与心率变异性(HRV)的中西医研究进展.目前西医治疗主要有抗心律失常药物、射频消融以及植入式心律转复除颤器,抗心律失常药物存在不良反应,手术价格高昂且存在一定风险.中医药治疗发挥其整体治疗的优势,不仅能改善临床症状,而且能改善自主神经功能.

Atrial fibrillation (AF) is one of the most common cardiac arrhythmias and can lead to heart failure (HF), stroke, pulmonary embolism (PE), and other complications, seriously affecting people’s quality of life and health. Western medicine is limited in the treatment of AF, while Traditional Chinese Medicine (TCM) has unique advantages, such as less side effects, low toxicity, long effect duration, and high compliance. The prescription of HTDJ is a common prescription for the treatment of atrial fibrillation in Longhua Hospital, Shanghai University of Traditional Chinese Medicine. It has been used for many years and has a large number of clinically effective cases. It has a good clinical application prospect, but there is a lack of effective evaluation of its clinical efficacy. This study adopts a randomized double-blind, single-simulated, placebo-controlled research method. Participants were randomly assigned in a 1:1 ratio through a centrally controlled, computer-generated, simple randomization schedule. Participants would take the medicine for 1 month, and the curative effect would be evaluated. Subsequently, the participants would not take TCM and only receive western medicine treatment. They would be followed up for another 8 weeks, and a clinical evaluation would be conducted. The secondary outcomes include echocardiography, Hamilton Anxiety Scale, Hamilton Depression Scale, rate of increase and decrease of anti-arrhythmia western medicine, the MOS 36-item short-form health survey, N-terminal-pro hormone B-type natriuretic peptide level, and integral TCM syndrome score. Adverse events will be monitored throughout the trial. Cases are from outpatient and inpatient with atrial fibrillation in the Cardiology Department of Longhua Hospital. Evaluations will be conducted at baseline and at weeks 4 and 12 after randomization. In this study, the efficacy and safety of HTDJ plus western medicine in the treatment of atrial fibrillation (qi deficiency and phlegm opacities) will be evaluated, so as to provide medical evidence of short-term and medium-term clinical efficacy for the treatment of atrial fibrillation with integrated traditional and western medicine and lay a foundation for further clinical development and application. ClinicalTrials.gov ChiCTR2000030517 . Registered on March 5, 2020, with the Chinese Clinical Trial Registry

目的 观察耳穴疗法在老年高血压病病人心脏康复中的作用及临床疗效.方法 选取2016年1月—2016年12月上海中医药大学附属龙华医院住院部及门诊部收治的老年原发性高血压病人123例,分为对照组(61例)与治疗组(62例).对照组病人给予常规标准西药治疗,治疗组病人在西医治疗常规上加用中医耳穴疗法,每穴按压10 min,每日自行按压3次,每周更换1次,双耳交替.两组均以1周为1个疗程,共治疗4个疗程,疗程间休息1 d.结果 治疗组降压疗效总有效率为91.9％,明显高于对照组的73.8％,差异具有统计学意义(P<0.05);治疗后,治疗组收缩压、舒张压、中医证候积分明显低于对照组,差异具有统计学意义(P<0.01).结论 中医耳穴联合西药治疗老年原发性高血压,可明显降低血压,同时能有效降低中医证候积分,提高临床疗效.

Tetrahydropalmatine (THP) is an active natural alkaloid isolated from Corydalis yanhusuo W.T. Wang which has been widely used for treating pain and cardiovascular disease in traditional Chinese medicine. Previous studies suggested THP have various pharmacological effects in neural and cardio tissue while the vascular reactivity of THP was not fully established. The present study found that THP relaxed rat aorta which contracted by phenylephrine (Phe), KCl, and U46619. The vascular relaxation effect of THP was partially attenuated by PI3K inhibitor wortmannin, Akt inhibitor IV, endothelial nitric oxide synthetase (eNOS) inhibitor L-NAME, guanylate cyclase inhibitors and the mechanical removal of endothelium. Also, the eNOS substrate L-arginine reversed the inhibition effect of L-NAME on THP-induced vascular relaxation. THP also induced intracellular NO production in human umbilical vein endothelial cells. However, Pre-incubation with β-adrenergic receptor blocker propranolol, angiotensin II receptor 1 (AT1) inhibitor losartan, angiotensin II receptor 2 (AT1) inhibitor PD123319 or angiotensin converting enzyme inhibitor enalapril enhanced the vascular relaxation effect of THP. THP did not affect the angiotensin II induced vascular contraction. Cyclooxygenase-2 (COX2) inhibitor indomethacin did not affect the vascular relaxation effect of THP. Furthermore, pre-treatment THP attenuated KCl and Phe induced rat aorta contraction in standard Krebs solution. In Ca2+ free Krebs solution, THP inhibited the Ca2+ induced vascular contraction under KCl or Phe stress and reduced KCl stressed Ca2+ influx in rat vascular smooth muscle cells. THP also inhibited intracellular Ca2+ release induced vascular contraction by blocking Ryr or IP3 receptors. In addition, the voltage-dependent K+ channel (Kv) blocker 4-aminopyridine, ATP-sensitive K+ channel (KATP) blocker glibenclamide and inward rectifying K+ channel blocker BaCl2 attenuated THP induced vascular relaxation regardless of the Ca2+-activated K+ channel (KCa) blocker tetraethylammonium. Thus, we could conclude that THP relaxed rat aorta in an endothelium-dependent and independent manner. The underlying mechanism of THP relaxing rat aorta involved PI3K/Akt/eNOS/NO/cGMP signaling path-way, Ca2+ channels and K+ channels rather than COX2, β-adrenergic receptor and renin-angiotensin system (RAS). These findings indicated that THP might be a potent treatment of diseases with vascular dysfunction like hypertension.

BackgroundAngiogenesis plays a critical role in ischemia disease like coronary heart disease. Shunxinyin formula has been developed for treating coronary heart disease according to the principle of traditional Chinese medicine while its underlying mechanism is not fully elucidated.PurposeHere, we hypothesize Shuxinyin formula could promote angiogenesis and microcirculation, and the underlying mechanism is also investigated.MethodsWe established the chemical profile of Shuxinyin (SXY) extract utilizing a UHPLC-Q/Exactive analysis system and evaluated its pro-angiogenesis effect in zebrafish model. The underlying mechanisms were investigated by combination of pharmacological experiments with transcriptome analysis in zebrafish. Zebrafish treated with VEGF was served as the positive control in present study.ResultsWe found SXY significantly enhanced the sub-intestinal vessel plexus (SIVs) growth in zebrafish. Co-treatment and post-treatment SXY attenuated VEGF receptor tyrosine kinase inhibitor II (VRI)-induced deficiency of intersegmental vessels (ISVs) in a concentration dependent manner. Post-treatment VEGF, which is a well-known angiogenesis driver, also partially ameliorated VRI-induced ISVs deficiency. In addition, SXY inhibited the down-regulation of VEGF receptors, including kdr, flt1 and kdrl, induced by VRI in zebrafish. The pro-angiogenesis effect of SXY on VRI-induced ISVs deficiency was suppressed by PI3K and JNK inhibitors, and Akt inhibitor abolished the pro-angiogenesis effect of SXY. The transcriptome profile of SXY preventing from VRI-induced vascular growth deficiency revealed that the underlying mechanisms were also co-related to cell junction, apoptosis and autophagy.ConclusionWe could conclude that SXY presented pro-angiogenesis effect and the action mechanisms were involved in VEGF/PI3K/Akt/MAPK signaling pathways, cell junction, apoptosis and autophagy.

何为急性冠状动脉综合征 急性冠状动脉综合征(ACS)是以冠状动脉粥样硬化斑块破裂或侵袭,继发完全或不完全闭塞性血栓形成为病理基础的一组临床综合征,包括不稳定性心绞痛、非ST段抬高心肌梗死和ST段抬高心肌梗死,其共同病理机制是斑块破裂伴随血栓形成.动脉粥样硬化易损斑块破裂是导致急性冠状动脉综合征发生的主要病理学基础.急性冠状动脉综合征是一种常见的严重的心血管疾病,常见于老年人群,男性,绝经后女性,吸烟者,患有高血压、糖尿病、高脂血症、腹型肥胖及有早发冠心病家族史的患者.

心理情绪障碍是原发性高血压病发生的危险因素,中医学认为,高血压病为“血脉之心”与“神明之心”功能异常所导致的形神合病,在临证治疗时应“双心同调、动静相和”,兼顾中药治疗、心理疏导、运动处方、功法导引等综合手段,以助患者平稳降压、提高生活质量.

Aim To investigate pro-angiogenic effect of SEHM formula on HUVEC cells in vitro and Zebrafish in vivo and the related action mechanism .Methods VEGFR tyrosine kinase inhibitor II ( VRI)-induced ze-brafish intersegmental vessels ( ISVs ) damaged model was established to observe the protective effect of SE-HM formula on ISVs under fluorescence microscope . The pro-angiogenic effect on subintestinal vessels ( SIVs ) of water decoction of SEHM formula in ze-brafish was observed and the mRNA level of VEGFRs , including flt-1, kdr, kdrl, was measured by real-time PCR.The experimental models of the HUVEC cells were set up and the toxicity and promoting proliferation effect of water decoction of SEHM formula in HUVEC cells were assessed by cell viability assay (MTT), and then the levels of Akt, p38, p-p38, p44/42, p-p44/42, VEGFR-1 were detected by Western blot at 6, 12 and 24 h.Results SEHM formula treatment groups could significantly protect VRI-induced zebrafish ISVs loss(P<0.01) and presented pro-angiogenic effect on zebrafish SIVs obviously(P<0.01).The mRNA level of VEGFRs, including flt-1, kdr, kdrl.was up-regula-ted by SEHM formula treatment group significantly (P<0.05) compared with VRI group.Compared with control group , and SEHM formula treatment group could apparently promote proliferation in HUVEC cells and up-regulate the level of Akt, p38, p-p38, p44/42, p-p44/42, VEGFR-1.Conclusions Water de-coction of SEHM formula could present pro-angiogenic effect on SIVs in zebrafish and promote proliferation of HUVEC cells significantly , and its action mechanism may be related to up-regulating the expression of VEG-FR.